Review Article : Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis

Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis

Aixing Pan, Yong Hai, Jincai Yang, Lijin Zhou, Xiaolong Chen & Hui Guo

European Spine Journal, 2016;  Vol. 25, Issue 5

Abstract

Purpose

This meta-analysis aimed to evaluate the efficacy of motion-preservation procedures to prevent the adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis) compared with fusion in lumbar spine.

Methods

PubMed, Embase and the Cochrane Library were comprehensively searched and a meta-analysis was performed of all randomized controlled trials and well designed prospective or retrospective comparative cohort studies assessing the lumbar fusion and motion-preservation procedures. We compared the ASDeg and ASDis rate, reoperation rate, operation time, blood loss, length of hospital stay, visual analogue scale (VAS) and oswestry disability index (ODI) improvement of the two procedures.

Results

A total of 15 studies consisting of 1474 patients were included in this study. The meta-analysis indicated that the prevalence of ASDeg, ASDis and reoperation rate on the adjacent level were lower in motion-preservation procedures group than in the fusion group (P = 0.001; P = 0.0004;P < 0.0001). Moreover, shorter length of hospital stay was found in motion-preservation procedures group (P < 0.0001). No difference was found in terms of operation time (P = 0.57), blood loss (P = 0.27), VAS (P = 0.76) and ODI improvement (P = 0.71) between the two groups.

Conclusions

The present evidences indicated that the motion-preservation procedures had an advantage on reducing the prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment degeneration compared with the lumbar fusion. And the clinical outcomes of the two procedures are similar.

Keywords

Adjacent segment degeneration Adjacent segment disease Lumbar spinal fusion Motion-preservation procedures Meta-analysis

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